All diseases that are visible on the skin can cause some discomfort and unease in public. A proper diagnosis helps to better understand what you are dealing with…...

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Signs and Symptoms

The classic finding of DH is itchy blisters and red skin lesions that occur in groups. Since DH is a skin manifestation of celiac disease, patients will also sometimes have gastrointestinal symptoms. These include abdominal bloating, cramping, pain, diarrhea, or constipation.

Causes

When a person with CD consumes gluten, the immune system responds by producing a type of antibody called immunoglobulin A (IgA). These IgA antibodies are directed against epidermal transglutaminase. These antibodies can travel to the skin where they bind to the epidermal transglutaminase protein.

The majority of patients with DH have CD as defined by damage to the villi in the small intestine. However, some patients may have a normal duodenal biopsy but nevertheless have their DH triggered by dietary gluten, which is why DH is sometimes referred to as “celiac disease of the skin”.

First-degree relatives of patients with CD and DH have an increased risk for CD and DH. The genes that are closely associated with both of these conditions are called HLA types.

Diagnosis

In addition to recognizing the clinical findings, a diagnosis of DH can be made by performing a specific type of skin biopsy called a punch biopsy. This involves injecting a local anesthetic and using a small, cookie-cutter-like punch to remove a small sample of the skin adjacent to where the lesions are. The incision is then closed with one stitch. The skin sample is analyzed using direct fluorescence microscopy. Skin biopsies of people with DH are positive for immunoglobulin A (IgA) deposits which will appear in a granular pattern.

Blood tests for antibodies that are commonly found in people with CD, such as anti-tissue glutaminase also supplement the diagnosis of DH. If blood antibody tests are positive and the skin punch biopsy has the typical findings of DH, patients do not need an intestinal biopsy to confirm the diagnosis of celiac disease.

Treatment

Following a strict life-long gluten-free diet is important for controlling DH. The gluten-free diet can be complex so patients should be referred to a registered dietitian with expertise in CD for a nutrition assessment, education, and follow-up. However, it can take one to two years even with a strictly gluten-free diet for the skin rash to totally resolve.

A family of antibiotics known as sulfones can also be prescribed to reduce the swelling and the discomfort caused by the rash. Dapsone is a common antibacterial within this family used to treat DH. Patients typically feel relief within 48 to 72 hours of taking this medication. This medication may be used along with other medications for at least 4-6 months. In some cases, it may be taken for longer. However, this medication does not replace the importance of maintaining a strict gluten-free diet.

The information in this section has been gathered from existing peer-reviewed and other literature and has been reviewed by expert dermatologists on the CSPA Medical Advisory Board.

Dermatitis herpetiformis (DH) is a chronic, autoimmune skin condition caused by a reaction to gluten ingestion. It is characterized by the presence of groups of itchy blisters and red skin lesions on both sides of the body. These are most commonly located on the elbows, knees, buttocks, lower back, and scalp. DH is a skin manifestation of celiac disease (CD).

DH affects 10-15% of people with celiac disease. It can affect people of all ages but most often appears for the first time in those ages 30 and 40.

Similar to CD, people of northern European descent are more likely than those of African or Asian heritage to develop DH.